Wang P, Rao W, Sun L W, Wu Y, Chen W J, Kang Y L, Hao S, Zhu G H, Huang W Y
Department of Nephrology and Rheumatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China.
Zhonghua Er Ke Za Zhi. 2018 Sep 2;56(9):657-661. doi: 10.3760/cma.j.issn.0578-1310.2018.09.005.
To summarize the characteristics of cuffed-tunneled catheters insertion and investigate the values of cuffed-tunneled catheters in pediatric patients. Between March 2015 and July 2017, all the pediatric patients who received maintenance hemodialysis at least 3 consecutive months in our center were included. Sixteen cuffed-tunneled hemodialysis catheters were inserted in patients for long-term hemodialysis access. The clinical manifestations and complications were retrospectively reviewed. Fifteen pediatric patients with end stage ranal disease (ESRD) were included in this study and they received 16 cuffed-tunneled catheters for long-term vascular access, including 10 males and 5 females; median age at start of catheter insertion was 11.5 (4.2-14.5) years. Body weight was (27.8±8.0)kg (16.0-39.4 kg) . The size and the length of the catheters were based on the height of patients as follows: 28 cm for (115.6±10.6) cm (102.0-130.0 cm) ,36 cm for (148.6±9.9)cm (140.0-167.0 cm) . Cuffed-tunneled catheters outcome: 10 cuffed-tunneled catheters were still functional at the end of the study; 5 catheters were removed after successful kidney transplantation. Catheter failure occurred in 1 out of 16 cuffed-tunneled catheters due to catheter-related infections. The median catheter survival time was 11.9 months (range 3.5-21.3 months). Complications of cuffed-tunneled catheters: Catheter placements operation was successful in 15 cases using ultrasound guidance. No serious complications were observed in any patients receiving catheter inserting operation. The overall rate of catheter-related infections and thrombosis/malposition was 6.3% and 18.7%, respectively. Ultrasound guidance is suggested in pediatric patients during the catheters insertion. The size and the length of the catheters should be based on the height of patients. Cuffed-tunneled hemodialysis catheters could be effectively used for maintenance of hemodialysis vascular access for pediatric patients with ESRD.
总结带 cuff 的隧道式导管插入术的特点，并探讨带 cuff 的隧道式导管在儿科患者中的应用价值。2015 年 3 月至 2017 年 7 月期间，纳入在本中心接受至少连续 3 个月维持性血液透析的所有儿科患者。为 16 例患者插入带 cuff 的隧道式血液透析导管以建立长期血液透析通路。对临床表现和并发症进行回顾性分析。本研究纳入 15 例终末期肾病（ESRD）儿科患者，他们接受了 16 根带 cuff 的隧道式导管作为长期血管通路，其中男性 10 例，女性 5 例；导管插入开始时的中位年龄为 11.5（4.2 - 14.5）岁。体重为（27.8±8.0）kg（16.0 - 39.4 kg）。导管的尺寸和长度根据患者身高确定如下：身高（115.6±10.6）cm（102.0 - 130.0 cm）者用 28 cm 导管，身高（148.6±9.9）cm（140.0 - 167.0 cm）者用 36 cm 导管。带 cuff 的隧道式导管使用结果：研究结束时 10 根带 cuff 的隧道式导管仍可使用；5 根导管在肾移植成功后拔除。16 根带 cuff 的隧道式导管中有 1 根因导管相关感染而失败。导管中位存活时间为 11.9 个月（范围 3.5 - 21.3 个月）。带 cuff 的隧道式导管并发症：15 例在超声引导下导管置入手术成功。接受导管插入手术的患者均未观察到严重并发症。导管相关感染和血栓形成/位置异常的总体发生率分别为 6.3%和 18.7%。建议在儿科患者导管插入过程中采用超声引导。导管的尺寸和长度应根据患者身高确定。带 cuff 的隧道式血液透析导管可有效用于维持 ESRD 儿科患者的血液透析血管通路。
